The Selection of Anti-Microbial Drugs for Patients of Different Categories

¹ The Medical Service, Sea View Hospital.

1. Tuberculosis therapy has been complicated rather than simplified by the introduction of newer effective drugs.

2. Omitting the sulphones (for which there has been some recent renewal of interest) and the semicarbazones, the important drugs are isoniazid, streptomycin and PAS in various combinations.

3. Potentially important are pyrazinamide and oxytetracycline.

4. Less effectual against the tubercle bacillus but with special fields of usefulness are iproniazid and viomycin.

5. Of uncertain usefulness are salts of isoniazid and chemical conjugations between streptomycin and isoniazid and PAS or AS and isoniazid.

6. Still under investigation but immensely interesting is Cycloserine.®

7. Choice of drug regimens depends upon initial evaluation of the patient, estimation of sensitivities and minute knowledge of the history of the disease in the given patient.

8. Drug regimens should always include isoniazid unless allergy or toxicity rule otherwise.

9. Minimal lesions call for concurrent therapy.

10. Protracted disease calls for consecutive therapy.

11. Therapy should be continued for one to one and a half years excepting in special instances, such as the post-surgery patient or the recent primary when duration of therapy may be considerably less.

12. Pleural effusions, presumed tuberculous, call for isoniazid or isoniazid plus PAS therapy.

13. Miliary tuberculosis requires combined therapy, one of the members of which must always be isoniazid.

14. Ambulatory therapy is feasible in many instances but is allowable only after careful analysis of the case.